adult men may reduce by half their risk of contracting
HIV through heterosexual intercourse, the U.S.
government announced Wednesday, as it shut down two
studies in Africa testing the link. The National
Institutes of Health closed the studies in Kenya and Uganda
early, after safety monitors took a look at initial results
this week and noted the degree of protection. The
studies' uncircumcised men are being offered the
chance to undergo the procedure.
The link between male circumcision and HIV
prevention was noted as long ago as the late 1980s.
The first major clinical trial, of 3,000 men in South
Africa, found last year that circumcision cut the HIV risk
Still, many AIDS specialists had been awaiting
the NIH's results as a final confirmation. "Male
circumcision can lower both an individual's risk of
infection and, hopefully, the rate of HIV spread through the
community," said AIDS expert Dr. Anthony Fauci, director of
the NIH's National Institute of Allergy and Infectious Diseases.
But it's not perfect protection, Fauci stressed.
Men who become circumcised must not quit using condoms
nor take other risks, and circumcision offers no
protection from HIV acquired through anal sex or
injection drug use, he noted. "It's not a magic bullet but a
potentially important intervention," agreed Dr. Kevin De
Cock of the World Health Organization.
Male circumcision is common at birth in the
United States. But in sub-Saharan Africa, home to more
than half of the world's almost 40 million
HIV-infected people, there are large swaths of populations
where male circumcision is rare.
The WHO plans an international meeting early
next year to discuss the studies' results and how to
translate them into policies that promote safe male
circumcision performed by trained health workers with
sterile equipment while also teaching men that it
won't make them invulnerable.
If male circumcision were widely adopted,
officials predicted, it could help to avert tens of
thousands of HIV infections in coming years; Fauci
cited one model from South Africa that suggested up to 2
million infections could be averted over a decade.
"This is tremendous news, and it could help
millions of men while in turn reducing the risk faced
by millions of women," said Paul Zeitz of the Global
Why would male circumcision play a role? Cells
in the foreskin of the penis are particularly
susceptible to HIV infection, Fauci explained. Also,
the foreskin is more fragile than the tougher skin
surrounding it, providing a surface that the virus can
penetrate more easily.
Researchers enrolled 2,784 HIV-negative men in
Kisumu, Kenya, and 4,996 HIV-negative men in Rakai,
Uganda, in the studies. Over two years,
circumcised participants in the Kenya study were 53%
less likely than the uncircumcised men to become infected.
In Uganda, infection among circumcised men saw a 48%
decline compared to their uncircumcised counterparts.
The researchers are offering all of the studies'
uncircumcised men the chance to undergo the procedure,
and 80% of the uncircumcised Ugandans already have
agreed, said lead researcher Ronald Gray of Johns Hopkins
University. Side effects were rare--mostly mild
infections that were easily treated. The rate of side
effects was comparable to those seen in circumcised
U.S. infants, said Robert Bailey of the University of
Illinois at Chicago, who led the Kenyan trial. (Lauran